Tuesday, May 15, 2007

Unintended consequences

Kaiser released a homeless woman from ER back onto the street. There is now a call to forbid ERs from releasing people to the street.

The idea of taking someone who is down and out, and sending them back to skid row is decidedly icky, and I can see why people would want to pass a law against that. The problem is that it will shut down ERs.

Right now, ERs are required by law to serve *everyone*, no matter if they can pay or not. This means that they serve as primary care/shelter/hang-out spot etc. for homeless folks who, for whatever reason, do not want to stay in homeless shelters (this was certainly true in Boston where my wife worked). Once the person was done with their hospital visit, they needed to be discharged from the ER so a new person could be admitted. A new law would require them to be sent to an address, but their actual home is the street.

If ERs cannot discharge homeless people to their "homes" (the street) then they will need to keep them in their ER, using up a bed which is now no longer available to a new patient. The result is gridlock. Please note, that releasing people to shelters is not an option since they do not wish to actually live in shelters (which is why they arrive with no return home address, if they were with a shelter, they would arrive with a shelter return address, and some do, but not the ones we are talking about here).

It's a sad situation to be sure, but keeping ERs from treating sick people is not the solution.